{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T08:24:19Z","timestamp":1773908659831,"version":"3.50.1"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,9,4]],"date-time":"2021-09-04T00:00:00Z","timestamp":1630713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The rise of cosmetic injectables has involved new clinical scenarios related to complications. The scenario of hyaluronic acid (HA) aesthetic interventional\u2013induced visual loss has become more recognized. Although this complication is rare, there can be delayed recognition and treatment, with limited opportunity to evaluate potential treatments and establish best practice guidelines.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The authors report a case of documented visual recovery with extra-orbital and intra-orbital hyaluronidase. Central retinal artery occlusion is an ischemic event requiring urgent intervention. The authors hope to assist protocols being developed for HA aesthetic interventional\u2013induced visual loss.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Following loss of vision, 675 international units (IU) of hyaluronidase was given immediately to the injection site and extra-orbital area. Within 4 hours, 3000 IU intra-orbital and 1500 IU extra-orbital hyaluronidase were given.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Visual loss in a 38-year-old female, following ipsilateral nasal injection of 0.15 mL of HA filler Juv\u00e9derm Voluma via the nasal tip, was documented at no perception of light with afferent pupil defect, central retinal artery occlusion, and fundoscopy showing a cherry red spot. This was associated with cerebral irritation and magnetic resonance imaging ischemia. Hyaluronidase was injected as described above. The following day, visual acuity (VA) in the affected eye recovered to 6\/18 with a relative superior visual field scotoma. The VA improved to 6\/6 at 1 month.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The authors believe immediate injection followed by high dose intra-orbital and extra-orbital injection of hyaluronidase had a positive effect in this case. Recovery of vision was remarkable, from no perception of light to 6\/6, documented at a tertiary referral eye hospital.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of Evidence: 4<\/jats:title>\n                  <jats:p\/>\n               <\/jats:sec>","DOI":"10.1093\/asj\/sjab334","type":"journal-article","created":{"date-parts":[[2021,9,4]],"date-time":"2021-09-04T13:51:20Z","timestamp":1630763480000},"page":"411-416","source":"Crossref","is-referenced-by-count":15,"title":["Cosmetic Filler Blindness: Recovery After Repeated Hyaluronidase Injections"],"prefix":"10.1093","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2023-9591","authenticated-orcid":false,"given":"Jennifer J","family":"Danks","sequence":"first","affiliation":[{"name":"Department of Oculoplastics, Sydney Eye Hospital , Sydney, New South Wales , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James D","family":"Dalgliesh","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology , Sydney, Eye Hospital, Sydney, New South Wales , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Ayton","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology , Sydney, Eye Hospital, Sydney, New South Wales , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,9,4]]},"reference":[{"issue":"4","key":"2022112218050806500_CIT0001","doi-asserted-by":"crossref","first-page":"297","DOI":"10.5999\/aps.2020.00752","article-title":"Hyaluronidase: an overview of its properties, applications, and side effects","volume":"47","author":"Jung","year":"2020","journal-title":"Arch Plast Surg"},{"issue":"9","key":"2022112218050806500_CIT0002","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1093\/asj\/sjz312","article-title":"A consensus on minimizing the risk of hyaluronic acid embolic visual loss and suggestions for immediate bedside management","volume":"40","author":"Goodman","year":"2020","journal-title":"Aesthet Surg J"},{"issue":"1","key":"2022112218050806500_CIT0003","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/jocd.12672","article-title":"The treatment of hyaluronic acid aesthetic interventional induced visual loss (AIIVL): a consensus on practical guidance","volume":"18","author":"Humzah","year":"2019","journal-title":"J Cosmet Dermatol"},{"issue":"1","key":"2022112218050806500_CIT0004","doi-asserted-by":"crossref","first-page":"39","DOI":"10.3109\/01658107.2013.830134","article-title":"Therapeutic intra-arterial hyaluronidase infusion for ophthalmic artery occlusion following cosmetic facial filler (hyaluronic acid) injection","volume":"38","author":"Oh","year":"2014","journal-title":"Neuroophthalmology"},{"issue":"2","key":"2022112218050806500_CIT0005","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/PRS.0000000000005806","article-title":"Assessing retrobulbar hyaluronidase as a treatment for filler-induced blindness in a cadaver model","volume":"144","author":"Paap","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"2022112218050806500_CIT0006","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1097\/PRS.0000000000007155","article-title":"The functional anatomy of the ophthalmic angiosome and its implications in blindness as a complication of cosmetic facial filler procedures","volume":"146","author":"Taylor","year":"2020","journal-title":"Plast Reconstr Surg"},{"key":"2022112218050806500_CIT0007","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1016\/j.bjps.2020.10.051","article-title":"Response of twelve different hyaluronic acid gels to varying doses of recombinant human hyaluronidase","volume":"74","author":"Ryu","year":"2021","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"3","key":"2022112218050806500_CIT0008","doi-asserted-by":"crossref","first-page":"339","DOI":"10.5301\/ejo.5001065","article-title":"Hyaluronidase injection for improved tissue dissection in Baerveldt tube surgery","volume":"28","author":"Zahavi","year":"2018","journal-title":"Eur J Ophthalmol"},{"issue":"1","key":"2022112218050806500_CIT0009","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1093\/asj\/sjw216","article-title":"Efficacy of retrobulbar hyaluronidase injection for visual impairment resulting from hyaluronic acid filler embolization","volume":"38","author":"Zhu","year":"2018","journal-title":"Aesthet Surg J"},{"issue":"4","key":"2022112218050806500_CIT0010","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.ajo.2012.04.019","article-title":"Iatrogenic retinal artery occlusion caused by cosmetic facial filler injections","volume":"154","author":"Park","year":"2012","journal-title":"Am J Ophthalmol"},{"issue":"10","key":"2022112218050806500_CIT0011","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.4187\/respcare.01666","article-title":"Pulmonary emboli from therapeutic sodium hyaluronate","volume":"57","author":"Bhagat","year":"2012","journal-title":"Respir Care"},{"issue":"1","key":"2022112218050806500_CIT0012","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/j.1440-0960.2009.00593.x","article-title":"Hyaluronidase allergy: a rare cause of periorbital inflammation","volume":"51","author":"Borchard","year":"2010","journal-title":"Australas J Dermatol"}],"container-title":["Aesthetic Surgery 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